Grant: Knowledge Synthesis Grant

Bronchiolitis; Bronchodilators; Comparative Effectiveness Review; Epinephrine; Hypertonic Saline; Meta-Analysis; Network Meta-Analysis; Pediatrics; Randomized Controlled Trials; Systematic Review

<html> <body> <p> <strong>Background:</strong> Bronchiolitis is the most common disease of the lower respiratory tract during the first year of life. There is wide variation in the management of acute bronchiolitis throughout the world, which suggests that the ideal treatment has not yet been identified. Canadian studies show wide practice variation both within and across sites. In a national needs assessment we recently completed for a National Center of Excellence, front-line healthcare providers identified bronchiolitis as a priority for knowledge synthesis and translation. Large, multi-center&nbsp;randomized controlled trials (RCTs) on bronchiolitis treatment have been completed in recent years. Given new evidence from these potentially pivotal trials, rigorous syntheses incorporating the most current evidence and cutting-edge methodologies are required.<br> </p> <p> <strong>Objective:</strong> To evaluate the comparative effectiveness of the most promising agents for the acute management of bronchiolitis through network meta-analysis: bronchodilators, steroids, bronchodilators and steroids combined, hypertonic saline, and high-flow oxygen.<br> </p> <p> <strong>Research Plan:</strong> We will follow methodology advocated by The Cochrane Collaboration enhanced by the most current methodological evidence. We will follow standard, documented procedures for refining the research question, literature searching, screening and selecting studies for inclusion, assessing risk of bias, synthesizing results, and grading quality of evidence. Studies will be included if they are RCTs involving children &le;24 months with bronchiolitis, and evaluate any of the above interventions compared to placebo or another intervention. The primary outcome will be rate of admission for outpatients and length of stay for inpatients. Secondary outcomes will include: clinical scores and physiological measures; quality of life; and adverse effects. We will conduct standard pair-wise meta-analysis for each comparison, and network meta-analysis to assess comparative effectiveness across interventions. Analyses will be conducted separately for outpatients vs. inpatients and first-time vs. recurrent wheezers.<br> </p> <p> <strong>Team:</strong> Our team has international recognition and extensive experience in knowledge synthesis, as well as clinical and research expertise in emergency medicine and respiratory illnesses, including bronchiolitis. We have Knowledge Users that represent key national organizations that will assist with ensuring clinical relevance of the review, and interpretation, presentation, and dissemination of results to a widespread audience. These organizations are Translating Emergency Knowledge for Kids (TREKK), a National Center of Excellence in Knowledge Mobilization; Pediatric Emergency Research Canada (PERC), an organized network of pediatric emergency healthcare providers in Canada; and, the Emergency Medicine Section of the Canadian Paediatric Society.<br> </p> <p> <strong>Significance:</strong> Despite the frequency of bronchiolitis, the acute management of these children varies substantially. This research will synthesize evidence for the most promising management strategies for children with bronchiolitis in the acute care setting. The results will be disseminated broadly through a National Center of Excellence. The results will help standardize and optimize care for these children and identify research priorities. This research is relevant to a number of stakeholders including administrators, clinicians, researchers, funders, and most importantly, children and their families.</p> </body> </html>